A76-year-old man was transferred to our hospital for evaluation of continuous abdominal pain with systemic inflammation. Clinical examinations suggested the pressure of an adynamic ileus due to diverculitis and an infrarenal abdominal aortic aneurysm. Thirty-eight millimeter in diameter despite the commencement of antibiotic therapy, the symptoms progressively worsened and repeated CT scan demonstrated a rupture of the aneurysm without any enlargement in diameter. An emergency operation was done, and the patient was discharged on the 77th postoperative day. Blood culture and histological findings disclosed an infected aortic aneurysm due to Listeria monocytogenes. The possibility of aortic infection should be considered in patients showing a sudden rupture of an aortic aneurysm.

The utilization of generic drugs in medical practice has been promoted in Japan for the purpose of minimizing drug costs. In order to determine the clinical efficacy of the original preparation of glycyrrhizin, in comparison to its generic drug, a controlled longitudinal study was done of 82 consecutive patients with chronic hepatitis C receiving the original preparation of glycyrrhizin for 6 months. Patients treated with the original preparation of glycyrrhizin for 6 months at two hospitals were separated into two groups for study: Patients who changed from the original preparation of glycyrrhizin to a generic drug and then changed back from the generic drug to the original preparation of glycyrrhizin (Group A, n=46) ; and, patients who were continuously treated with the original preparation of glycyrrhizin (Group B, n=36) . HCV RNA levels were serially determined by Cobas Amplicor HCV Monitor assay. In Group A, the ALT level significantly elevated 3 months after switching treatment from the original preparation of glycyrrhizin to the generic drug (from 65.1 ±22.7 IU/L to 1 12.4±39.9 IU/L) (P<0.05), then significantly decreased 3 months after the change back to the original preparation of glycyrrhizin (from 112.4±39.9 IU/L to 62.1±23.0 IU/L) (P<0.05) . In Group B, however, the ALT level did not significantly change during the same observation period. The serum HCV RNA level did not significantly change in either group, even in Group A patients whose ALT levels significantly changed. The efficacy on ALT of the original preparation of glycyrrhizin and the generic drugs differed in patients with chronic hepatitis C.

　　A 38-year-old woman was examined at our hospital because of cough, night sweats, and facial edema. Computed tomography of the chest revealed a large mass in the anterior mediastinum measuring 8.2×12.2 cm, with multiple nodules on both lungs. Bronchoscopy revealed multiple nodules parallel to the tracheal rings and obstruction of the anterior segmental bronchus of the right lung. The histopathological features were diagnostic of primary mediastinal large B-cell lymphoma. She underwent chemotherapy followed by radiation therapy to the mediastinal mass. After 8 months, she developed right cerebellar metastasis. Eventually, she received peripheral stem cell transplantation after 17 months.

Objective: Since the conventional drip-infusion method for measuring inulin clearance (Cin) has problems related to its accuracy and performance, we explored a more accurate and concise method by rapid intravenous injection of a newly developed inulin fraction (Inulead^®), in which spot urine sampling was omitted and the administration period of inulin was shortened from 120 to 5 minutes. Patients and Methods: Twenty seven patients (M/F: 15/12, 67.8 ± 12.9 years old) admitted to the Nephrology ward were enrolled in this study. Inulead^®, 1500 mg dissolved in 150 mL of saline, was intravenously administered in 5 minutes. Then, sequential blood samplings and urine collection were performed for 24 hours. Cins were calculated by the following three formulae: (1) a pharmacokinetic analysis using a two compartments model based on the plasma inulin concentration to determine Cin, which was the administered dose divided by the area under the curve (AUC) from 0 to ∞, (2) urinary inulin excretion divided by the AUC for 24 hours and (3) the Bayesian method using a three-point set of plasma inulin concentrations to predict the change of inulin concentration to determine Cin as in 1. These Cins were compared with levels of estimated GFR (eGFR), creatinine clearance (Ccr), serum β2 microglobulin (β2MG) and serum cystatin C (Cys C). Results: Cins obtained by the above three methods were well correlated with each other (r. = 0.9088 – 0.9998) and with eGFR (r. = 0.8286 – 0.8650), Ccr (r. = 0.821 – 0.864), 1/β2MG (r. = 0.631 –0.752) and 1/CysC (r. = 0.830 – 0.857). The averaged differences of each Cin from eGFR were distributed between –4.4 and –4.5 mL/min. Conclusion: Since the Cins by rapid inulin injection showed satisfactory correlation and differences with other GFR parameters, this method will be a good alternative to the drip infusion method, and may reduce the burden of patients and medical staff.

Objective: Prescription check and inquiry is one of the most important operations of pharmacists to provide optimal drug therapy to the patient.  Although a number of studies related to inquiries of prescriptions have already been reported, there is little report about requests for doctor and hospital based on the examples.  Therefore, this study aimed to clarify the current problems revealed by inquiries about prescriptions by not only analyzing these inquiries but also investigating requests for doctors and hospitals.
Methods: We investigated 6,255 inquiries about prescriptions and requests for doctors and hospitals at 584 insurance pharmacies from August 4 to 10, 2014.  Then, the inquiries about prescriptions and requests for doctors and hospitals were categorized.
Results: The most frequent category of inquiries about prescriptions was “Questions about administration and dosage” (21.5%).  On the contrary, the most frequent request for doctors was “Efficiency in gathering information from and providing information to a patient” (2,067 cases).
Conclusions: The present study clarified current problems revealed by inquiries about prescriptions by investigating requests for doctors and hospitals that were based on examples.  Furthermore, the problems were classified into ten categories, and these should be noted by doctors and hospitals at the time the prescription was issued.

Cerebral stroke in rural areas is a very important disease both from medical and social aspects. Among strokes, infarction which occurs most frequently in elderly persons is liable to result from atherosclerosis. And for the development of atherosclerosis, essential hypertension is the most important predisposing factor. Other than hypertension, aging, diabetes mellitus, hyperlipemia, esp. low HDL/Tch ratio, increased hematocrit values, coronary insufficiency, cardiac failure, arythmia, esp. atrial fibrillation, are also accepted important risk factors. Affirmative of such findings, the authors are convinced of the fact that atrial fibrillation which is increasing recently is closely related to both cerebral thrombosis and embolism.
But, in regard to cerebral infarction no signifying or trigger factor, similar to very high blood pressure, that trigger cerebral hemorrhage, is clarified as yet. It is made clear in this connection that cardiac failure predisposed by hypertensive heart disease in old age, assisted by pathophysiological and other environmental conditions, is the important factor. The authors also studied the clinical predisposing parameters and preventive measures about strokes.

Cerebrovascular disease is still considered a serious health problem in Japanese rural areas. The rate of death from the disease is very high. Many clinical and epidemiological studies have been conducted so far. However, they have failed to come up with answers effective for prediction and prevention of the scourge.
As part of the agricultural coop commissioned research project entitled “Study of Cerebral Apoplexy: Its Prediction and Prevention, ” we took a questionnaire survey in 1985-86, to obtain data as regards patients' subjective symptoms, electrocardiographic observations, hematological findings and many others before the onset of cerebral apoplexy. Five medical research institutes affiliated with the national welfare federation of agricultural cooperatives responded to our questionnaire.
As a result, the subjective symptoms that showed stochastically significant increases from one year to three months before the onset of the disease as a whole were fatigue, forgetfulness and insomnia. When it comes to cerebrovascular infarction, shortness of breath, angina, forgetfulness, and nocturia were particularly notable.
All these symptoms are not peculiar to cerebral apoplexy, but it should be noted that these are the warning signals of the killer disease.

Using immunohistochemical staining for alpha-smooth muscle actin (alpha-SMA), glial fibrillary acidic protein (GFAP), S100 protein (S100), p63, cytokeratin 14 (CK14), and cytokeratin 19 (CK19), we studied acinar and myoepithelial cells of major and minor salivary glands obtained from 14 donated cadavers (78-92 years old) and 5 donated fetuses (aborted at 15-16 weeks of gestation). CK and p63 expression was investigated only in the adult specimens. SMA was detected in all adult glands as well as in fetal sublingual and pharyngeal glands. GFAP expression was seen in a limited number of cells in adult glands, but was highly expressed in fetal pharyngeal glands. S100-positive myoepithelial-like cells were present in adult minor glands as well as in fetal sublingual and pharyngeal glands. Expression of p63 was evident in the ducts of adult glands. CK14 immunoreactivity was observed in a limited number of glandular cells in adults, in contrast to consistent expression of CK19. In both adults and fetuses, a mosaic expression pattern was usually evident for each of the examined proteins. A difference in immunoreactivity for the nerve markers GFAP and S100 was observed between the major and minor glands. Thus, in the present histologic study, we distinguished between the specific gland types on the basis of their immunohistochemical staining. A mosaic expression pattern suggested that the immunoreactivity against nerve protein markers in myoepithelial cells could not be due to the persistence of neural crest remnants or the physiological status of the gland, such as age-related degeneration.
Actins ; Adult ; Aged ; Cadaver ; Fetus ; Glial Fibrillary Acidic Protein ; Humans ; Immunohistochemistry ; Keratin-14 ; Keratin-19 ; Muscles ; Neural Crest ; Population Characteristics ; Proteins ; Salivary Glands ; Salivary Glands, Minor

The supinator muscle originates from the annular ligament of the radius, and the muscle fibers and ligament take a similar winding course. Likewise, the coccygeus muscle and the sacrospinous ligament are attached together, and show a similar fiber orientation. During dissection of adult cadavers for our educational curriculum, we had the impression that these ligaments grow in combination with degeneration of parts of the muscles. In histological sections of 25 human fetuses at 10-32 weeks of gestation, we found that the proximal parts of the supinator muscle were embedded in collagenous tissue when the developing annular ligament of the radius joined the thick intermuscular connecting band extending between the extensor carpi radialis and anconeus muscles at 18-22 weeks of gestation, and the anterior parts of the coccygeus muscle were surrounded by collagenous tissue when the intramuscular tendon became the sacrospinous ligament at 28-32 weeks. Parts of these two muscles each seemed to provide a mold for the ligament, and finally became involved with it. This may be the first report to indicate that a growing ligament has potential to injure parts of the "mother muscle," and that this process may be involved in the initial development of the ligament.
Adult ; Cadaver ; Collagen ; Curriculum ; Fetus ; Fungi ; Humans ; Ligaments ; Muscles ; Orientation ; Pregnancy ; Radius ; Tendons ; Wind

OBJECTIVESTo assess trends in smoking prevalence among Japanese adolescents and to analyze possible causal factors for the decrease in smoking prevalence observed in a 2004 survey.

METHODSNationwide cross-sectional surveys were conducted in 1996, 2000 and 2004. Survey schools, both junior and senior high schools, considered to be representative of the whole of Japan were sampled randomly. Enrolled students were asked to complete a self-reporting anonymous questionnaire on smoking behavior. The questionnaires were collected from 115,814 students in 1996, 106,297 in 2000, and 102,451 in 2004. School principals were asked about the policy of their respective school on smoking restrictions.

RESULTSCigarette smoking prevalence (lifetime, current, and daily smoking) in 2004, based on the completed questionnaires, had decreased relative to previous years in both sexes and in all school grades. The most important trends were: a decrease in smoking prevalence among the fathers and older brothers of the students; an increase in the proportion of students who did not have friends; a decrease in the proportion of current smokers who usually bought cigarettes in stores decreased in 2004, in particular for the oldest boys. An association was found between a lower smoking rate at a school and a smoke-free school policy.

CONCLUSIONSJapan has experienced a decrease in the prevalence of smoking among adolescents. A decrease in smoking prevalence among the fathers and older brothers, limitations to minors' access to tobacco, an increase in the proportion of students without friends, and a school policy restricting smoking may have contributed to this decreasing trend.